The Link Between Oral Health and Heart, Brain, and Body

Natalie Tysdal (01:17)

Dr. Ingram, thank you for joining me.

Dr. Toni Engram (01:20)

Absolutely, Natalie, thank you for having me.

Natalie Tysdal (01:22)

Let's start with what a biological dentist is.

Dr. Toni Engram (01:27)

Yeah, so a lot of times people will use the term holistic or a functional dentist. Some people will say biomimetic, but biological dentistry is really taking this concept ⁓ from biological medicine where we're really focusing on the entire human body. So what do we do in the mouth that supports the health of the body or

what could be going on in the mouth that might be contributing to you're not feeling great, to sickness and disease. And it's focusing on the whole body, on the mouth in the context of the entire body. So in practicality, that means we focus a lot on prevention. We try to avoid dentistry whenever possible. And when we do need to do dentistry,

then we're really focused on making sure that we're intentional with the materials that we use and focusing on whole body health in that context.

Natalie Tysdal (02:29)

So I want to be sure we put this in context of also overall medicine, because I interview all kinds of doctors, from functional doctors to MDs, nurses, you name it. But is this a trend we're seeing that more people are going holistic in dentistry? Because we're certainly seeing people wanting to be more holistic ⁓ in regular medicine. So is this something that's growing in the dentistry world?

Dr. Toni Engram (02:56)

It is really, really growing and I'm so excited about it. So I would say my predecessors who practiced biological dentistry, ⁓ starting in the 70s, 80s and 80s and 90s were kind of known as like the hippie versions of dentists. But the more we find out, the more science there is behind what we do, the

more the movement I think is really expanding. And so there are just a growing number of dentists who are interested in it because there's a growing number of patients who are requesting and demanding that they be treated this way.

Natalie Tysdal (03:42)

So help us also understand why it's important. What are some of the things, when I go to my dentist every six months, we do a cleaning, they do x-rays, they do the typical things to be sure that everything's good and you're not, you know, have no decay, all of that, but are you doing the same things and are you trained the same way?

Dr. Toni Engram (04:04)

So we all go to the same types of dental schools. I am sad to report that it is not a recognized specialty. So all of the extra training that we have in biological dentistry is all something that we have voluntarily signed up for. It is training beyond our education. ⁓ It is training in the principles and the science behind biological dentistry.

Natalie Tysdal (04:31)

your training is the same. You still went to dental school as everyone else, but then you went above and beyond.

Dr. Toni Engram (04:38)

Yes, so dental school is the same.

practice dentistry under our dental license. And so we do all of the same traditional training, but we've voluntarily signed up for extra training and education in these concepts, in the science, and the practice behind biological dentistry.

Natalie Tysdal (05:02)

You know, we see so much of this in other forms of medicine, in functional medicine. It's kind of a demand from consumers in wanting to understand this. But why is it important? ⁓ What are some of the things that you do differently from a standard dentist? Give me examples.

Dr. Toni Engram (05:22)

So we still do many of the things the same. So we still do cleanings, we still do fillings and crowns and all of these things. But we do take, because we take more of a whole body approach, more of a holistic approach, we are talking about nutrition and ways to avoid interventional treatments first. When there are small cavities, we are working with patients on

all the ways to reverse those and get those to heal before they need treatment, hopefully, before I have to take a drill to them. ⁓ Same thing with gum disease. When we can catch it early, then if we can treat it with diet and lifestyle and the things that you're doing at home to help your body heal and thrive and function the way that it needs to, then that's what we wanna do because many, many times,

Less dentistry is better dentistry. Many times. ⁓ But it's when we do need to intervene, then we've got some really cool tools in our tool belt that I think are safer, that have a better track record, that are gentler on the body than maybe what we've used in the past. So I...

I really am careful with the materials that we use. I don't use any fluoride in the office at all.

Natalie Tysdal (06:48)

Okay,

let's talk about that because every time we go to our dentist and most people, they'll say fluoride today and we hear so much controversy on it. Can you explain why you don't use it or why you would recommend people not use it?

Dr. Toni Engram (07:04)

Yeah, absolutely. And a lot of it is because we're exposed to so much of it, because it's in the water supply. So fluoride is an effective tool at reducing the rate of tooth decay. It is, it's effective at that, but it's maybe not as effective as we once thought, because...

You know, the rate of tooth decay after we started fluoridating our water, the rate of tooth decay in the United States did decrease fairly significantly. But what's also important to note is that tooth decay in other countries that did not fluoridate their water, it decreased at the same rate. And so when you look globally, you really can't attribute this decrease in tooth decay primarily to fluoride. It's

there are many other factors involved like diet and nutrition and you know, oral hygiene and all of these other lifestyle factors were at play. So, it's maybe not as effective as we once thought and in the on the opposite side of the coin, it is perhaps far more risky than we were taught in school. So, study after study now is coming out showing that

there actually is a correlation with increased levels of fluoride and poor health effects like decreased IQ in our children. ⁓ There are most of my functional medicine doctors who refer to me, really don't want their patients to be using any fluoride because it competes with, for iodine in the thyroid. ⁓ There are concerns about it calcifying the pineal gland. ⁓

But really it's the studies, the more recent studies on IQ and children and the health of our children that are most concerning and have the most data to back them up. So those things being said, it's maybe not as effective as we once thought. It's more risky than we once thought. So to me, it is just not the bee's knees like I was taught in dental school.

And the fact that we cannot control the dose. So because it's in our water, that means that Joe Blow grandpa who's 70 years old and drinks one glass of water a day, his dose, the amount of fluoride he's getting per kilogram of body weight is completely different than an infant who is 10 pounds.

and getting formula that is mixed with tap water and that's their sole source of nutrients. Their dose per kilogram of body weight is vastly different. So because we can't control the dose, we actually don't know what amount is more risky, what amount is safe. We just don't have a clue right now. And so me ethically as a dentist,

I know that I have other tools in my tool belt that can be as effective, if not more effective than fluoride without that risk profile. And so I choose to avoid it. And I typically have my patients avoid it as well, which means we don't have it in the office or the toothpaste that we use don't have any fluoride, all of the materials we have to filter through to avoid the fluoride.

Natalie Tysdal (10:41)

Well, I don't think it's easy when you go to the drug store or the grocery store and you're picking up some of the products that we use for oral hygiene, mouthwash, toothpaste. Can you talk about that from your perspective as well? What's in many of the products and in your opinion, what the best products to use for overall health would be?

Dr. Toni Engram (11:05)

Well, just like anything, we keep packaging products and using, finding ingredients that are cheaper, that give us still the same user experience, that aren't necessarily helpful for us. And so you wind up with, you're just picking things off the drugstore, you wind up with a lot of weird stuff in your mouth. ⁓ So you don't need the fluorides, you really don't.

Most of the time you don't need any kind of anti-microbial, you know, don't need the alcohol-based mouth washes. ⁓ There's a lot of foaming ingredients in sulfates, in toothpaste, these things that you just don't need. So most of the time, simple is best. And the simpler you can be with your ingredients, most of the time, the better off you are.

Now I'll be really strategic with my patients and if we're trying to get over the hump and we're trying to actually fix an imbalance, if we're trying to reset their microbiome, if we're trying to rebalance the bacteria in their mouth ⁓ based on saliva testing and really looking at their risk level, then I may put them on something strategically with active ingredients. Like I may use a stronger mouthwash for a period of time.

We may be using a stronger toothpaste for a period of time. But then once they're healthy, then we go back to what is simple and healthy and safe ⁓ that just supports the mouth rather than blasting it with things we don't need.

Natalie Tysdal (12:44)

So it's not a one size fits all toothpaste, which is, think, probably what most people are used to. You buy the same thing for your whole family. But I'm hearing you talk about the mouth's microbiome, like we often talk about the gut microbiome, and finding that balance.

Dr. Toni Engram (13:00)

Yes, and it is incredibly diverse and it affects the microbiome in your gut, you know, because you're swallowing saliva and seeding your gut with some of the bacteria that's in your mouth. And so it's really important that we treat the microbiome in our mouth like it's a garden and we want to tend to the garden. We don't necessarily want to take a blowtorch to it or take Roundup to the whole thing.

which a lot of the mouth washes on the market are really just like round up for your mouth. They're killing everything indiscriminately when really we should be treating the mouth much more gently, treating the microbiome with much more care and support rather than blasting it.

Natalie Tysdal (13:47)

Why is that so important? We hear about the gut microbiome and finding that balance, but why in the mouth is that so important?

Dr. Toni Engram (13:55)

Well, the best analogy I have is if you've ever taken antibiotics and had really nasty stomach issues after the fact, or you've gotten a yeast infection, or you wind up with diarrhea, it's because the antibiotic killed the good bacteria with the bad. And when you kill the good with the bad, then sometimes what is left is a gut that's really out of balance.

and the pathogens tend to want to take over. So same thing in the mouth. If you're using ⁓ something in a bright blue bottle that's mostly alcohol, ⁓ then you're going to wipe out the good with the bad and you wind up with things really out of balance. Not to mention that those, the things in the bright blue bottle is really, really acidic. So it's not doing the pH of your mouth any favors.

And then that just sets you on this cycle for things to be out of balance. It dries out the mouth. More pathogens have a chance to take over because there are pathogens that like things to be drier and acidic so that they can take hold and really lock in and create their own biofilm. ⁓ Whereas the more beneficial bacteria, they like to breathe. They like oxygen. They like saliva.

And they like for things to be, they like for the pH to be relatively neutral. They're not creating their own acid like some of the pathogens are. So it really just takes not blasting the mouth with all the different chemicals.

Natalie Tysdal (15:36)

That's a good, really good analogy, but how do you know? So can you tell as soon as you look in someone's mouth what they need to do or how do you test for that?

Dr. Toni Engram (15:45)

So I really, really like saliva testing where we will actually take a saliva sample and we'll send it off to the lab to see what's there. ⁓ Now, obviously I've been looking at mouths for a very long time. So I can tell when things are out of balance. You can tell by looking if the mouth is dry or they'll get this ring of inflammation in the gum tissue, just this ring of red right around the teeth that shows us either things are too dry or things are out of balance.

Obviously bleeding gums because even if you're not bleeding when you brush, maybe you're not bleeding when you floss, but sometimes when we go in and we measure with our little rulers that we use around the gum tissue, then we'll get some bleeding there. Or maybe, you know, well, some people just don't really floss effectively. They're not flossing well enough. And so, so we'll see the bleeding even if they haven't just because they're not using the floss very effectively.

So yes, there are signs and we can tell, obviously it's so much better when we can see specifically what's there. Because there are some pathogens that are associated with inflammation, they're associated with gum disease, but maybe that's about it. But then there are other pathogens, things like porphyromonous gingivalis, some actinomyces species. There are things that are directly correlated with an increased risk of other health issues.

That's where we see the links to heart attack and stroke, rheumatoid arthritis, Alzheimer's, with pregnancy complications, fertility issues, erectile dysfunction. And if we can see some of those bad guys, some of those pathogens that we're really worried about, then we know we're gonna treat it differently. We're gonna hit things a little harder before we start. You know, we may take a blow torch to things for a couple of weeks to knock everything down if we have to.

knowing that then we're going to go back and seed the saliva with the good bacteria after the fact.

Natalie Tysdal (17:49)

So all of those things that you just mentioned, it makes me think if all of our ⁓ providers work together, the overall person is better. So all of those things you mentioned in pregnancy or ED or heart issues, do you then give that to your patient or work with their other providers for the whole person? And how does that work?

Dr. Toni Engram (18:11)

100%. I've got a lot of people on speed dial. That's how it works. I absolutely love working with the functional medicine doctors in the area, even the chiropractors, the integrative physicians. It's so important and can be so beneficial when we work together. And I can send them a saliva test.

to say, okay, here's what we've got going on. Here's how I'm going to treat it, but I'm concerned about this as well. What do you think? ⁓ And they, you some of them are very comfortable reading the saliva tests that we use and some of them aren't and just want to know how we want to fix it, ⁓ which is all great. And so yes, absolutely 100 % when I can work with other providers, then we get the best outcomes for patients for sure.

Natalie Tysdal (19:05)

Okay, let's switch gears for a minute because I hear a lot of people talking, you see a lot of this on social media, on tongue scraping. And you see a film on someone's tongue. Do you look inside and go, okay, that's not good? And are there some other general practices that you would recommend like tongue scraping?

Dr. Toni Engram (19:24)

I love tongue scraping. It does such a better job than just brushing your tongue with a toothbrush. ⁓ So I am ⁓ a huge fan of tongue scraping. And it's, don't know, it gets, I try to keep up with what goes on on social media, but sometimes it gets hard. But I did see something recently that was, you know, proclaiming the dangers of tongue scraping because you could, you know,

you had a increased risk of cutting your tongue and introducing some of that bacteria into your bloodstream from your tongue. I will say for the record, I have literally never seen a tongue scraping injury on a patient. I have seen flossing injuries many times. I've seen flossing injuries, but I've never seen a tongue scraping injury. So I am a fan of.

Natalie Tysdal (20:17)

What's the benefit?

What does it do though? Why should people do it since you like it so much?

Dr. Toni Engram (20:23)

It's the same concept as brushing and flossing. How you want to keep things in balance is you want to disrupt the biofilm that's in your mouth. And the tongue, because it's got all these little grooves and ridges and taste buds, has a ton of nooks and crannies, ⁓ just like your English muffin, ⁓ tons of nooks and crannies for bacteria to hide and create a biofilm.

And so if you're never disrupting that biofilm with either tooth brushing or tongue scraping, then it will build up and get fairly thick and can be the place where some of those pathogens take hold. So, you know, the way that we keep the bacteria levels where they need to be at healthy levels where the pathogens aren't happy, but the good bacteria are happy is we disrupt the biofilm on a regular basis.

And so that's with usually brushing and flossing a couple of times a day and tongue scraping once a day, just so you keep things thinned out.

Natalie Tysdal (21:31)

Wow, there's just so much. Any other general mouth care tips that you would give?

Dr. Toni Engram (21:39)

So simple as best, brushing, flossing. If you can't floss, because I'm not just a stickler that you have to floss and it has to be with string and it has to be a certain kind. I'm just happy if you get anything in between your teeth. So for some people, especially for older people or for dudes, anybody who doesn't have just beautiful long thin piano fingers,

then a water pick sometimes works great, something in between the teeth. Really something that is great for the health of your mouth that you wouldn't necessarily think is mouth taping at night.

Natalie Tysdal (22:21)

Yeah, this is another big social media thing we hear about. Why is that good?

Dr. Toni Engram (22:25)

It is because if you happen to sleep with your mouth open, just mouth breathing at night can actually set you up for a whole host of poor oral health issues. So it's not good for your sleep ⁓ because you want to be breathing through your nose. That stimulates the parasympathetic nervous system. It's just better practice to breathe through your nose.

⁓ You want your air to be filtered through the nose instead of just going directly in through your mouth. But in terms of oral health, your mouth will dry out as you sleep and then that dryness again will lower the pH of your mouth so things will be more acidic. You won't be able to naturally wash away as much of the plaque and bacteria that's in your mouth when you have less saliva. ⁓

And so it creates this kind of inflammatory cycle where things are more inflamed, you're more prone to cavities, all because you've slept with your mouth open. So mouth taping is great for that.

Natalie Tysdal (23:30)

That's yeah. And you

see mouth tape. I mean, I don't know if you can use just any tape, but you see.

Dr. Toni Engram (23:36)

You really can't. Medical

tape is just fine. ⁓ But the mouth tapes, some of them are kind of cute now. And so if you want to be fancy and get a fancy mouth tape, you can.

Natalie Tysdal (23:46)

That's great. Super. Where can people learn more about you? And if someone is thinking, I would like to see someone like Dr. Tony, where, where could they find someone in their area? How do you look for that?

Dr. Toni Engram (23:59)

Yeah, so I try to put out a ton of educational content online. Probably my biggest platform is on Instagram, so you can find me at Dr. Tony Ingram on Instagram. I'm on YouTube and the other platforms as well. Our website is www.flourish.dental. That's my practice website in the Dallas area, and we are just as happy as can be if anybody wants to drive down or fly down and come visit.

⁓ We'll get everything taken care of and send you back to your regular dentist when you go back home. ⁓ If you want to look and see if there is a dentist who's like-minded, who's in your area, then really the group that has the biggest directory is the IAOMT. ⁓ So again, it's iaomt.org and that website has a great directory of different dentists.

who you can even look them up by how many conferences they've been to, know, are they accredited, are they certified. So you can kind of filter things out based on their experience in biological dentistry if you like and find one who's in your state, hopefully close to you in your city even, but there's a growing number of us. So hopefully it's easier and easier for you to find someone who is

similar similar values.

Natalie Tysdal (25:28)

Well, thank you for educating us. A lot of really interesting information I certainly hadn't thought of. And I know everyone listening would feel the same. So thank you so much. It's just been a pleasure.

Dr. Toni Engram (25:39)

you're welcome. Thank you so much.